HEALTHY VISION 2020 I SPECIAL REPORT SPECIAL REPORT
Texas and the Patient Protection and Affordable Care Act
The U.S. Supreme Court has upheld most serious challenges to the constitutionality of the Patient Protection and Affordable Care Act (PPACA). The court’s decision will have lasting implications for Texas’ health care delivery system. Of course, the outcome of the upcoming November presidential election also will have an impact. Nonetheless, at both the federal and state levels, all of us must work aggressively to make sure that Texas patients have access to high-quality health care services in the most appropriate setting.
The PPACA imposes certain requirements on Texans. Large employers with more than 300 employees, if they offer coverage, must automatically enroll new employees in their health benefits plans. Large employers generally must offer benefits or pay a penalty. Individuals must purchase insurance either through their employer or through an insurance exchange. Texas, like all other states, must determine the essential health benefits to be provided in an exchange in conjunction with edicts from the federal government. Our lawmakers also must decide whether Austin — or Washington — will run the Texas exchange.
Within days of the Supreme Court giving states the option, Gov. Rick Perry announced his opposition to expanding Medicaid under the PPACA to cover about 1.6 million more low-income Texans. Pointing to the record low number of Texas physicians who are accepting new Medicaid patients,106
TMA is also questioning the wisdom
of Medicaid expansion. If doctors can’t participate because of the system, then Medicaid is broken, and you cannot fix a broken system simply by making it bigger. We have to make it different.
The state also has an important role that is essentially unaddressed in the PPACA: ensuring we will have enough physicians to deliver care that meets Texans’ health care demands.
Depending on the elections and the will of state
legislators around the country, the number of legal nonelderly residents with insurance could rise from 82 percent in 2012 to 93 percent by 2022. From 2016 on, the Congressional Budget Office estimates that the PPACA would reduce the number of uninsured to 26- 27 million. Around 16-17 million of the newly covered persons — most of them poor adults without children — would be enrolled in Medicaid.107
“We are going to have a lot more insured people, and it isn’t only that they’ll be getting routine services. …These [newly insured] people aren’t routine. They have a lifelong reservoir of poor health.”
Richard “Buz” Cooper, MD, professor of medicine, University of Pennsylvania School of Medicine
In Texas, 6.5 million people lack insurance coverage; that number would drop to 2.3 million should the insurance exchanges and the PPACA Medicaid expansion come to fruition.108
This means that 4.2
million Texans would have some new form of financing to support access to medical care after 2014. Meanwhile, the supply of physicians (although increasing due to Texas tort reforms) would be wholly inadequate to meet the new demand. In fact, according to the Association of American Medical Colleges, the nation could face a shortage of as many as 150,000 doctors in the next 15 years.109
Because physicians and emergency departments (EDs) must treat first and ask about coverage later, this shortage will cause serious ripples throughout our health care system.
February 2013 TEXAS MEDICINE 63
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